Provider Demographics
NPI:1245561968
Name:WELLNESS PHARMACY MURFREESBORO LLC
Entity Type:Organization
Organization Name:WELLNESS PHARMACY MURFREESBORO LLC
Other - Org Name:THE WELLNESS PHARMACY MURFREESBORO, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMD
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCKNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-941-8333
Mailing Address - Street 1:2644 SEQUOYA TRCE
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37127-8362
Mailing Address - Country:US
Mailing Address - Phone:615-867-4181
Mailing Address - Fax:
Practice Address - Street 1:1547 WARRIOR DRIVE
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37128
Practice Address - Country:US
Practice Address - Phone:615-941-8333
Practice Address - Fax:615-941-8336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-20
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN47293336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4442935OtherNCPDP PROVIDER IDENTIFICATION NUMBER